trauma 2 - dentine and enamel fractures Flashcards
(35 cards)
what is enamel infractions?
> incomplete fracture of enamel without loss of tooth structure
how do you treat enamel infractions ?
> Monitor
> Occasionally etch and seal if sensitive
what is a minimal enamel fracture?
> Loss of tooth substance confined to enamel
what is the treatment for a minimal enamel fracture?
> Leave (smooth if necessary)
> Composite restoration
> Splint if any mobility
> Periodic review = Radiographic + Sensibility
if a patient has an enamel fracture in a primary tooth what is the treatment?
> Monitor
> Usually sufficient to smooth if possible to prevent soft tissue damage
what is an uncomplicated enamel dentine fracture?
> Loss of tooth substance confined to enamel and dentine and not involving the pulp
what are the treatment aims of uncomplicated enamel dentine fractures ?
> Protect the pulp (maintain vitality)
- Bacterial / thermal irritation to exposed dentinal tubules
> Restoration of the crown
- Maintain space
what are the emergency treatment options for fractures teeth?
- > Dress exposed dentine with glass ionomer
Composite bandage / composite crown build up - reattachment of fragment
describe option 2 of the emergency treatments? (reattachment)
> Immediately reattach fragment if possible
> If fracture close to pulp – indirect pulp cap
> Dress exposed dentine with glass ionomer
- Thin lining / cement over dentine, aim to maintain vitality
- Delay placement of fragment and store in milk / saline
what is the technique for reattachment of fragments?
- Check vitality of tooth
- Check fit of fragment
- Keep fragment hydrated
- Isolate tooth - rubber dam
- Attach fragment to gutta percha for handling
- Etch enamel on both fracture sites & 2mm margins
- Wash, dry, apply primer
- Bonding agent
(Note - Do NOT dessicate fragments)
- Place composite –remove excess
- Finish
- Follow up
- Monitor vitality
- Monitor colour changes
how do you treat enamel dentine fractures in primary teeth?
> Glass ionomer dressing to protect dentine and decrease sensitivity if sufficient cooperation
> Smooth if possible to prevent soft tissue trauma
what is a complicated fracture?
> when the pulp is involved
what are factors to consider when a child has a pulp fracture?
> Time from pulp exposure
> Size of pulp exposure
> Stage of root development
> Age of child – cooperation
what are the options to consider when a child has a pulp fracture?
> pulp cap
> pulpotomy
> pulpectomy
when do you chose to pulp cap in a child with a pulp fracture?
> Short time
> pin point exposure
> poor co - operation
> Prognosis better if seen < 24 hrs
how is a pulp cap placed?
> layer of CaOH2, placed directly over exposed pulp
> bandage of GI or comp
what is the aim of a pulp cap?
> preserve vital pulp, bridge of reparative dentine
when monitoring the vitality and taking radiographs of a pulp capped tooth, what do you exclude?
> exclude resorption and necrosis
what would child who has had a pulp fracture have to present with for you to consider a pulptomy as a treatment option?
> Incomplete apex / complete apex
> Small exposure
> Vital pulp, not infected
> Patient co-operative
what is the aim and success of a pulpotomy?
> Allow continued root growth – apexogenesis
> Avoid need for open apex RCT – apexification
> 80-96% success rate
what is the treatment steps for a pulpotomy? (ASAP)
1.Local anaesthetic
2. Isolation
3. Remove non vital tissue (2-3mm)
4. Non setting Calcium Hydroxide
5. No pressure
6. Glass ionomer dressing
7. Other materials used –MTA or biodentine
8. Review = Radiographs at 1 month, then 3-6 month! Check hard tissue barrier formation! Check continued root growth
when would you carry out a pulpectomy on a child with pulpal fracture?
> Gross exposure / extrusion of pulp
> Complex crown / root fracture
> Necrotic pulp in open apex
what is the aim of a pulpectomy?
> maintain tooth
> weak tooth as no further development
what are the two treatment options of a pulpectomy?
> closed apex - standard RCT
> open apex - apexification
